open access

Vol 14, No 4 (2007)
Original articles
Published online: 2007-06-11
Submitted: 2013-01-14
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Is the combination therapy of IKr-channel blocker and left stellate ganglion block effective for intractable ventricular arrhythmia in a cardiopulmonary arrest patient?

Mari Amino, Koichiro Yoshioka, Seiji Morita, Hiroyuki Otsuka, Takeshi Yamagiwa, Kazuo Umezawa, Yoshihide Nakagawa, Isotoshi Yamamoto, Tadashi Hashida, Yuji Ikari, Sadaki Inokuchi, Itsuo Kodama, Teruhisa Tanabe
Cardiol J 2007;14(4):355-365.

open access

Vol 14, No 4 (2007)
Original articles
Published online: 2007-06-11
Submitted: 2013-01-14

Abstract


Background: We have previously reported that the defibrillation success rate of intravenous nifekalant hydrochloride (NIF), a pure IKr-channel (IKr: the rapid components of the delayed rectifier potassium current) blocker, was more than 75% for lidocaine-resistant ventricular tachycardia and fibrillation (VT/VF) in patients with out-of-hospital cardiopulmonary arrest (CPA). However, there was no effective treatment for the remaining 25% of patients in whom defibrillation was unsuccessful. We hypothesised that the combination therapy of NIF and left stellate ganglion block (LSGB) was useful for defibrillation in NIF-resistant VT/VF and investigated its efficacy in a retrospective study.
Methods and results: We investigated sequentially 272 out-of-hospital CPA patients treated at Tokai University between April and December 2006. VT/VF occurred in 55 patients on arrival or during cardiopulmonary resuscitation (CPR). On the basis of our CPR algorithm, NIF was administered (0.15-0.3 mg/kg, i.v.) after the first direct-current cardioversion. NIF-resistant VT/VFs were observed in 15 out of 55 patients and LSGB was performed on 11 of these with administration of NIF. Sinus rhythm was restored in 7 patients following LSGB (64%) and complete recovery was achieved in 2 patients. In the non-LSGB group, however, all the patients died.
Conclusions: The combination therapy of intravenous NIF and LSGB was useful for defibrillation in intractable VT/VF. It is a potential and innovative treatment strategy for IKr-channel blocker resistant VT/VF. (Cardiol J 2007; 14: 355-365)

Abstract


Background: We have previously reported that the defibrillation success rate of intravenous nifekalant hydrochloride (NIF), a pure IKr-channel (IKr: the rapid components of the delayed rectifier potassium current) blocker, was more than 75% for lidocaine-resistant ventricular tachycardia and fibrillation (VT/VF) in patients with out-of-hospital cardiopulmonary arrest (CPA). However, there was no effective treatment for the remaining 25% of patients in whom defibrillation was unsuccessful. We hypothesised that the combination therapy of NIF and left stellate ganglion block (LSGB) was useful for defibrillation in NIF-resistant VT/VF and investigated its efficacy in a retrospective study.
Methods and results: We investigated sequentially 272 out-of-hospital CPA patients treated at Tokai University between April and December 2006. VT/VF occurred in 55 patients on arrival or during cardiopulmonary resuscitation (CPR). On the basis of our CPR algorithm, NIF was administered (0.15-0.3 mg/kg, i.v.) after the first direct-current cardioversion. NIF-resistant VT/VFs were observed in 15 out of 55 patients and LSGB was performed on 11 of these with administration of NIF. Sinus rhythm was restored in 7 patients following LSGB (64%) and complete recovery was achieved in 2 patients. In the non-LSGB group, however, all the patients died.
Conclusions: The combination therapy of intravenous NIF and LSGB was useful for defibrillation in intractable VT/VF. It is a potential and innovative treatment strategy for IKr-channel blocker resistant VT/VF. (Cardiol J 2007; 14: 355-365)
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Keywords

combined therapy; nifekalant hydrochloride; left stellate ganglion block; out-of-hospital cardiopulmonary arrest; ventricular tachycardia; ventricular fibrillation

About this article
Title

Is the combination therapy of IKr-channel blocker and left stellate ganglion block effective for intractable ventricular arrhythmia in a cardiopulmonary arrest patient?

Journal

Cardiology Journal

Issue

Vol 14, No 4 (2007)

Pages

355-365

Published online

2007-06-11

Bibliographic record

Cardiol J 2007;14(4):355-365.

Keywords

combined therapy
nifekalant hydrochloride
left stellate ganglion block
out-of-hospital cardiopulmonary arrest
ventricular tachycardia
ventricular fibrillation

Authors

Mari Amino
Koichiro Yoshioka
Seiji Morita
Hiroyuki Otsuka
Takeshi Yamagiwa
Kazuo Umezawa
Yoshihide Nakagawa
Isotoshi Yamamoto
Tadashi Hashida
Yuji Ikari
Sadaki Inokuchi
Itsuo Kodama
Teruhisa Tanabe

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